Consistency between ultrasound-guided transperineal and transrectal prostate biopsy in the diagnosis of prostate cancer
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摘要:
目的探讨超声引导下经会阴与经直肠前列腺穿刺活检术在前列腺癌诊断的一致性。 方法收集2017年2月~2020年2月本院收治的121例行前列腺穿刺活检患者的临床资料，依据检查方法不同分为直肠检查组（n=60）和会阴检查组（n=61），分析两组对前列腺癌检出的一致性，比较两组对前列腺癌诊断的效能和对前列腺特异性抗原(PSA)灰区前列腺癌检出率，同时比较两组检查时间和并发症发生情况。 结果直肠检查组对前列腺癌检出的Kappa值0.699，与会阴检查组对前列腺癌检出的Kappa值0.668相接近，直肠检查组对前列腺癌检出的敏感度87.1%、特异性82.8%、准确度85.0%，与会阴检查组（敏感度85.3%、特异度为81.5%、准确度83.6%）差异无统计学意义（P>0.05）。会阴检查组对PSA灰区前列腺癌检出率高于直肠检查组（P < 0.05），直肠检查组检查时间明显短于会阴检查组，但会阴检查组血便、发热发生率较直肠检查组明显更低（P < 0.05）。 结论超声引导下经会阴与经直肠前列腺穿刺活检术对前列腺癌检出的一致性相当，其中经会阴穿刺途径对PSA灰区前列腺癌检出率更高且安全性更好，但其检查时间较久，临床实践中可视患者具体病情选择最合理的穿刺方式。 Abstract:ObjectiveTo explore the consistency between ultrasound-guided transperineal and transrectal prostate biopsy in the diagnosis of prostate cancer. MethodsThe clinical data of 121 patients undergoing prostate biopsy who were admitted to the hospital from February 2017 to February 2020 were collected. According to different examination methods, they were divided into rectum examination group (n=60) and perineum examination group (n=61). The consistency between the two groups in the diagnosis of prostate cancer was analyzed. The diagnostic efficiency of prostate cancer, detection rate of prostate cancer in PSA gray zone, examination time and occurrence of complications were compared between the two groups. ResultsKappa value in rectum examination group was close to that in perineum examination group for diagnosis of prostate cancer (0.699 vs 0.668). The sensitivity, specificity and accuracy for diagnosis of prostate cancer in rectum examination group were 87.1%, 82.8% and 85.0%, without significant difference compared with those in perineum examination group (85.3%, 81.5%, 83.6%) (P>0.05). The detection rate of prostate cancer in PSA gray area in perineum examination group was significantly higher than that in rectum examination group (P < 0.05). The examination time in rectum examination group was significantly shorter than that in perineum examination group, while incidence of bloody stool and fever was significantly higher than that in perineum examination group (P < 0.05). ConclusionConsistency between ultrasound- guided transperineal and transrectal prostate biopsy is comparable in the diagnosis of prostate cancer. The detection rate of prostate cancer in PSA gray area is higher by the former, with higher safety. However, its examination time is longer. In clinical practice, the most reasonable puncture method can be selected according to the specific conditions of patients. -
Key words:
- prostate cancer /
- ultrasound guidance /
- transperineal /
- transrectal /
- prostate biopsy
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图 1 不同穿刺途径下PC影像学图片
A: 经会阴穿刺; B: 经直肠穿刺
Figure 1. Imaging picture of PC under different puncture routes.
表 1 两组对前列腺癌检出一致性分析
Table 1. Consistency analysis of prostate cancer detection between the two groups (n)
分组 病理诊断 合计 阳性 阴性 直肠检查组（n=60） 阳性 27 5 32 阴性 4 24 28 合计 31 29 60 会阴检查组（n=61） 阳性 29 5 34 阴性 5 22 27 合计 34 27 61 
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表 2 两组对前列腺癌诊断的效能比较
Table 2. Comparison of the effectiveness of the two groups in the diagnosis of prostate cancer(%)
组别 敏感度 特异性 准确度 直肠检查组（n=60） 87.1（27/31） 82.8（24/29） 85.0（51/60） χ2 0.044 0.016 0.044 会阴检查组（n=61） 85.3（29/34） 81.5（22/27） 83.6（51/61） P 0.834 0.901 0.833
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表 3 两组对PSA灰区前列腺癌检出率比较
Table 3. Comparison of detection rate of prostate cancer in PSA gray area between two groups
组别 检出例数（n） 检出率（%） 直肠检查组（n=21） 4 19.05 会阴检查组（n=21） 13 59.09 χ2 7.207 P 0.007
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表 4 两组检查时间和并发症发生率比较
Table 4. Comparison of examination time and complication rate between the two groups[n(%)]
组别 检查时间（min，Mean±SD） 血便 血尿 尿潴留 发热 疼痛 直肠检查组（n=60） 16.34±3.28 8（13.33） 30（50.00） 2（3.33） 9（15.00） 1（1.67） 会阴检查组（n=61） 30.29±5.49 1（1.64） 35（57.38） 3（4.92） 1（1.64） 6（9.84） χ2/连续校正χ2/t 16.932 4.430* 0.662 0.000* 5.469* 2.357 P ＜0.001 0.035 0.416 0.985 0.019 0.125
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